Q:  Questions if  This Treatment Plan is Typical

Since my son was small, I tried to get him diagnosed with various things.  Knowing something (mood-wise) was up.  As he got older, judgement seemed to be a problem and I realized he was not a self starter, but performed best when he was kept busy by outside ifluences ie., school, sports, job.  Academically he was always very smart without trying very hard. Recently, my son (20)came home for Christmas break from college and was more withdrawn and quiet than ever.  I noticed he has several "cut" marks up and down his left arm.  I pressed, did some checking and found out he had also been using some serious drugs.  Something he despised in others.  We were shocked and brought him for an psychiatric evaluation as well as enrolled him in an  outpatient drug treatment facility. He was diagnosed with bipolar disorder (finally) and put on 100 mg of zoloft and .25 risperdal.  Yesterday at his check up she increased the risperdal dosage(.05) because he was becoming moody again

Something we all noticed for two days, but he actually mentioned it to me and to the doctor and I am grateful for that.  The icing on our cake is that we recently found out that during his "episode" at college he had casual sex with someone he did not know well and she is now having a baby.  Something she is thrilled about.  He is not.  We just added a psychotherapist to his seemingly growing list of specialists.

My question is: with the above in mind, are the medications he has been prescribed (100 MG. ZOLOFT, .25 AND .05 RISPERDAL DAILY) typical of what someone would be put on?  He has gained ten pounds and is voraciously hungry and thirsty too.   Thanks for your help.

Worried for life,
Denise


Dear Denise -- 
Presuming for the moment that the diagnosis of bipolar disorder is correct, you should probably have a look at some of the "treatment guidelines" that have been prepared by teams of bipolar experts.  Here's a review of several, but not all such guidelines -- though generally they are all quite similar with one exception: the Europeans are much less reluctant, generally, to use antidepressants compared to the Americans. There is quite a bit of debate about that.  You'll see that in the guidelines I'm referring to with that link, there is a relative de-emphasis on antidepressants and a relative emphasis on "mood stabilizers", of which risperidone would generally be considered to be one (though for most folks, at a substantially higher dose than your son is taking even after the increase). 

So, you could read up there and then very gently and carefully ask if the doc' could help you understand why the emphasis on antidepressants, the relative de-emphasis on the mood stabilizer (the low dose) -- after acknowledging that you understand there is considerable controversy about this kind of thing. My views on antidepressants are also to be found on various pages of my website, e.g. starting with Treatment section you'll find from this link, perhaps ultimately looking at the much more technical stuff on the Antidepressant Controversies page. 

In any case, you might find the page on "talking with doctors" useful. Good luck with this. You could connect with your local NAMI or DBSA groups for more support. 

Dr. Phelps

Published June, 2006